198016431-6-30-2023-54-CC-AESA-CTAUKT-20230630153941

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016431
Report Date: 06/30/2023
Date Signed: 06/30/2023 03:39:53 PM

Document Has Been Signed on 06/30/2023 03:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	GUTIERREZ FAMILY CHILD CARE		FACILITY NUMBER:	198016431
ADMINISTRATOR:	GUTIERREZ, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 639-4548
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	14	CENSUS: 5	DATE:	06/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Licensee Maria Gutierrez		TIME COMPLETED:	03:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Austin Estrada conducted an unannounced required 1-year inspection at the above facility. LPA met with the Licensee Maria Gutierrez and informed her of the purpose for the visit. LPA provided the inspection Entrance Checklist (LIC 126). Licensee guided LPA on a tour of the facility. There were 5 children present during the inspection. All adults present during the inspection have obtained a criminal record clearance or exemption. Individuals residing in the home have been discussed and noted. Licensee provides care to children ages newborn to 12 years old and operation days/ hours are Monday through Friday 6:00AM to 6:00PM. This is a single-story home. The home consists of 2 bedrooms, 1 bathroom, living room, dining area, kitchen, family room (day care room), patio, back yard with patio (fenced), front yard and garage. Areas accessible to children include the living room, dining area, kitchen, bathroom, family room and patio. Areas off limits to children include both bedrooms, front yard, backyard (fenced) and garage. The children use the bathroom located in the hallway. The restroom that children use was observed safe and sanitary. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. All documents were observed to be posted in the family room (day care room). Facility records were reviewed for LIC 9040- Facility Roster, LIC 610A- Emergency Disaster Plan and Verification of Disaster and Fire Drills. The last drill was conducted on 6/5/23. All documents were observed during the inspection. There is an operable carbon monoxide detector and a smoke detector in the home. A fully charged Fire extinguisher (2A10BC) was observed and last serviced on 2/26/23. The home maintains telephone service (landline/mobile/both). LPA observed cleaning compounds and sharp objects such as knives located in the kitchen inaccessible to children in care. Per Licensee, no children require medication. Per Licensee there are no poisons stored in the home. LPA advised Licensee that all poisons must be

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 198016431
	VISIT DATE: 06/30/2023

NARRATIVE

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locked away, not only inaccessible. Isolation area for sick children waiting to be picked up is in the living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.
Food is provided by Licensee. LPA advised Licensee if children bring food from home, it must be labeled with the child’s name and properly stored or refrigerated.
The home is observed to be clean and orderly. There are toys and other age-appropriate materials available for children. Appropriate sleeping arrangements (cots) were observed. Per Licensee, sheets are provided by the facility and washed weekly. LPA observed one yard yard and one crib during the inspection.
The outdoor play area was observed to be fenced and contain toys and other age- appropriate materials available for children. The outdoor patio is used for outdoor play. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided. LPA observed the patio to be separated from the back yard area by a fence. There are two dogs located that are kept in the backyard. Per Licensee the dogs do not interact with children in care. Per Licensee, children are supervised while playing outside. LPA did not observe any pools, spas, or other bodies of water. During the inspection, children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful, and comfortable accommodations, furnishings, and equipment, and free from corporal and/or unusual punishment.
Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA did not observe LIC 995 A for 4 out of 5 children. LPA advised Licensee that all required documents including LC 995A should completed and available for review during inspections.
Personnel records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Licensee’s Mandated Reporter Training Certificate expires in June 2023. LPA observed Licensee to have a CPR/first aid training certificate that was not issued either by the American Red Cross or by a training program that has been approved by the Emergency Medical Services Authority. LPA provided Licensee a website (https://emsa.ca.gov) with EMSA approved vendors if needed.
Infant Care: Currently licensee cares for 1 infant. LPA reviewed Safe sleep regulations with Licensee, including LIC 9227 (Infant Sleep Plan) for infants under 12 months and 15-minute sleep check

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 198016431
	VISIT DATE: 06/30/2023

NARRATIVE

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documentation for infants 0-24 months. LPA discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA provided a copy of PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect.
Overnight Care: Per Licensee, overnight care is not provided.
Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing IMS must be submitted to the Department.
The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm
LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
LPA advised Licensee that all adults age 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
Based on the LPA’s observations, interviews and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. Deficiencies include two type B violations.
An exit interview was conducted, and report was reviewed with Licensee. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Appeal rights were discussed and provided to the Licensee.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/30/2023 03:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 198016431
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above: LPA did not observed a current pediatric first aid card issued either by the American Red Cross or by a training program that has been approved by the Emergency Medical Services Authority which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/14/2023
	Plan of Correction
1 2 3 4	Licensee will provide a current pediatric first aid card issued either by the American Red Cross or by a training program that has been approved by the Emergency Medical Services Authority to LPA via email by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

Document Has Been Signed on 06/30/2023 03:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: GUTIERREZ FAMILY CHILD CARE	FACILITY NUMBER: 198016431
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)(1)

Admission Procedures and Authorized Representatives Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 4 out of 5 children did not have LIC 995A in their files for LPA to review which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/14/2023
	Plan of Correction
1 2 3 4	Licensee will provide proof of completed LIC 995A to LPA via email by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC809 (FAS) - (06/04)

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